Objective To assess which bowel preparation agent is most effective.Methods A search of randomized trials between January 1990 and July 2005 was obtained, using MEDLINE and PubMed databases, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using the Forest plot review.Results Sodium phosphate (NaP) was more effective in bowel cleansing than polyethylene glycol (PEG) -odds ratio 0.75 (95%CI: 0.65-0.88; P ¼ 0.0004); and sodium picosulphate (SPS) -odds ratio 0.52 (95%CI: 0.34-0.81; P ¼ 0.004). PEG and SPS were comparable in bowel cleansing ability, odds ratio 1.69 (95%CI: 0.92-3.13; P ¼ 0.09). NaP was more easily completed by patients compared to PEG, odds ratio 0.16 (95%CI: 0.09-0.29; P < 0.00001). More patients were able to complete SPS than PEG, but this was not statistically significant -odds ratio 0.56 (95%CI: 0.28-1.13; P ¼ 0.11). NaP and PEG were comparable in terms of adverse events, odds ratio 0.98 (95%CI: 0.82-1.17; P ¼ 0.81), although NaP resulted in more asymptomatic hypokalaemia and hyperphosphataemia. NaP and SPS appeared to have similar incidence of adverse events. PEG resulted in more adverse events than SPS, odds ratio 3.82 (95%CI: 1.60-9.15; P ¼ 0.003).Conclusions NaP was more effective in bowel cleansing than PEG or SPS and was comparable in terms of adverse events. Patients have more difficulty completing PEG than NaP and SPS. Biochemical changes associated with a small-volume preparation like NaP, albeit largely asymptomatic, mandate caution in patients with cardiovascular or renal impairment.

Laparoscopic surgery for Crohn's disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohn's disease is both safe and feasible.

This review was designed to assess the various surgical options available for fecal incontinence and critically evaluate the evidence behind these procedures. The algorithm in the surgical treatment of fecal incontinence is shifting. Injectable therapy and sacral nerve stimulation are likely to be the mainstay in future treatment of moderate and severe fecal incontinence, respectively. Sphincteroplasty is limited to a small group of patients with isolated defect of the external sphincter. A stoma, although effective, can be avoided in most cases.

Hemorrhoidectomy by Harmonic Scalpel is comparable to diathermy hemorrhoidectomy in terms of postoperative pain and complications.

The time taken to perform laparoscopic surgery is similar to open surgery. Patients are able to tolerate oral intake earlier, and have a shorter hospitalization. Laparoscopic colectomy was safer compared to the open procedure, but both were equally safe for patients who had restorative proctocolectomy. Thus, laparoscopic surgery for ulcerative colitis is both safe and feasible.